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Joseph Bernstein

Publications and source records attributed to Joseph Bernstein.

24 records · Page 2Linked to original sources
PubMed2002

Educational deficiencies in musculoskeletal medicine.

BACKGROUND: We previously reported the results of a study in which a basic competency examination in musculoskeletal medicine was administered to a group of recent medical school graduates. This examination was validated by 124 orthopaedic program directors, and a passing grade of 73.1% was established. According to that criterion, 82% of the examinees failed to demonstrate basic competency in musculoskeletal medicine. It was suggested that perhaps a different passing grade would have been set by program directors of internal medicine departments. To test that hypothesis, and to determine whether the importance of the individual questions would be rated similarly, the validation process was repeated with program directors of internal medicine residency departments as subjects. METHODS: Our basic competency examination was sent to all 417 program directors of internal medicine departments in the United States. Each recipient was mailed a letter of introduction explaining the purpose of the study, a copy of the examination, and our answer key and scoring guide. There was no mention of the results of the first study. The subjects were requested to rate the importance of each question on the same visual analog scale, ranging from "not important" to "very important," as had been used by the orthopaedic program directors. These ratings were converted into numerical scores. The program directors were also asked to suggest a passing score for the examination, and this score was used to assess the examinees' performance on the examination. The results on the basis of the internal medicine program directors' responses and those according to the orthopaedic program directors' responses were compared. RESULTS: Two hundred and forty (58%) of the 417 program directors of internal medicine residency departments responded. They suggested a mean passing score (and standard deviation) of 70.0% +/- 9.9%. As reported previously, the mean test score of the eighty-five examinees was 59.6%. Sixty-six (78%) of them failed to demonstrate basic competency on the examination according to the criterion set by the internal medicine program directors. The internal medicine program directors assigned a mean importance score of 7.4 (of 10) to the questions on the examination compared with a mean score of 7.0 assigned by the orthopaedic program directors. The internal medicine program directors gave twenty-four of the twenty-five questions an importance score of at least 5 and seventeen of the twenty-five questions an importance score of at least 6.6. CONCLUSIONS: According to the standard suggested by the program directors of internal medicine residency departments, a large majority of the examinees once again failed to demonstrate basic competency in musculoskeletal medicine on the examination. It is therefore reasonable to conclude that medical school preparation in musculoskeletal medicine is inadequate.

Education, Medical, Graduate↗
PubMedDate not supplied

Evidence-based medicine.

Evidence-based medicine refers to an explicit process of using and evaluating information to make medical decisions. Evidence-based medicine, perhaps contrary to popular perception, requires its users to embrace uncertainty in medical decision making because information that is simultaneously true and complete cannot be attained. Recognizing medicine's inherent uncertainty, proponents of evidence-based medicine advocate using a five-step process for sound decision making: formulate answerable questions, gather evidence, appraise the evidence, implement the valid evidence, and evaluate the process. The formulation of answerable questions requires categorizing the facts of the case in terms that allow comparison to evidence gathered from prior studies. The appraisal of the evidence uses the tools of clinical epidemiology to assess the validity and applicability of the evidence. Implementation refers to the construction of a clinical plan based on the evidence collected as well as on the physician's judgment and patient's preferences. Finally, evidence-based medicine requires continued evaluation and refinement. The methods of evidence-based medicine are especially germane to contemporary medicine as physicians practice under increasing demands to deliver optimal outcomes yet face an ever-expanding body of medical knowledge.

Case-Control Studies↗